Post-Surgery Concerns After Anal Fissure Repair: What to Expect

Q: Post-Surgery Concerns After Anal Fissure Repair: What to Expect

Hello： In response to your question, anal fissures do require sphincterotomy surgery, but not all anal fissures necessitate surgery. <br>It's similar to how not every cold develops into pneumonia. <br>Surgery is only recommended if the pain from the anal fissure is unbearable and

Postoperative Issues After Anal Fissure Surgery

Hello Dr.
Ke, I underwent anal fissure surgery in November of last year (2005), and it has been over five months since then.
I found information online suggesting that anal fissure surgery typically involves cutting the sphincter muscle.
When I asked my doctor about it, he mentioned that a longitudinal incision with a horizontal suture was made, but other doctors said it was too technical for me to understand, so they didn't elaborate.
However, I often feel sensitivity at the surgical site, and after sitting for a long time, I frequently experience a sensation of urgency and leakage at the incision site, although I can still control flatulence and have not experienced true incontinence.
This sensation is quite uncomfortable and has been troubling me.
I have returned for follow-up visits several times, but the doctor only said that everything seemed fine without providing further explanation.
I am genuinely unsure whether there is really nothing wrong or if there is an issue that is being overlooked, as this feeling is quite distressing and distracting.
I am wondering if this is a normal condition following anal fissure surgery or if it is related to sphincter muscle damage.
Is there any way to improve this situation?

zhǎ, 30~39 year old female. Ask Date: 2006/04/08

Dr. Ke Fangxu reply Surgery

Hello: In response to your question, anal fissures do require sphincterotomy surgery, but not all anal fissures necessitate surgery.
It's similar to how not every cold develops into pneumonia.
Surgery is only recommended if the pain from the anal fissure is unbearable and cannot be managed with conservative treatment.
The surgical procedure involves cutting two-thirds of the internal anal sphincter.
Generally, suturing is not required.
The internal anal sphincter is a layer of circular muscle surrounding the lower rectum (imagine a long, tightly coiled thread).
Typically, a 0.5 cm incision is sufficient to access and incise the anal sphincter.
Most patients can return to normal activities within one to two weeks post-surgery.
If discomfort persists five months after the procedure, it would be advisable to consult the original surgeon.
If the surgery has indeed caused damage to the anal sphincter, there are methods to improve the situation.
Initially, medication can be administered, and if that proves ineffective, a sphincteroplasty may be performed.

Reply Date: 2006/04/08

More Info

After undergoing anal fissure repair surgery, it's common for patients to experience a range of sensations and discomforts as part of the healing process. Given that you had your surgery over five months ago, it's understandable that you have concerns about your recovery and the sensations you're experiencing.

Firstly, it's important to recognize that the surgical repair of an anal fissure often involves making incisions that can affect the surrounding tissues, including the anal sphincter. The procedure may involve a lateral internal sphincterotomy, which is designed to relieve tension on the fissure and promote healing. While this technique can be effective, it can also lead to changes in sensation and function in the anal area.

The sensitivity you are feeling at the surgical site is not uncommon. After surgery, the nerves in the area may take time to heal, and during this period, you might experience heightened sensitivity or discomfort. This can manifest as a feeling of pressure or urgency, especially after sitting for prolonged periods. The sensation of needing to have a bowel movement, even when you do not, can be a result of the surgical changes in the area and the healing process.
Regarding your concerns about potential incontinence or damage to the sphincter muscle, it is reassuring that you are able to control gas and bowel movements. This indicates that your sphincter function is likely intact. However, if you are experiencing persistent discomfort or unusual sensations, it is crucial to communicate this with your healthcare provider. They may recommend further evaluation to ensure that there are no complications, such as excessive scarring or other issues that could be contributing to your symptoms.

To improve your situation, consider the following recommendations:
1. Follow-Up Appointments: Continue to attend follow-up appointments with your surgeon or gastroenterologist. If you feel that your concerns are not being adequately addressed, do not hesitate to seek a second opinion or ask for a referral to a specialist in pelvic floor disorders.

2. Dietary Adjustments: Maintaining a high-fiber diet and staying well-hydrated can help ensure that your bowel movements are soft and regular, reducing strain during defecation. This can also help minimize discomfort in the anal area.

3. Pelvic Floor Therapy: If you are experiencing ongoing discomfort or issues with sensation, pelvic floor physical therapy may be beneficial. A specialized therapist can help you with exercises to strengthen the pelvic floor and improve muscle coordination.

4. Pain Management: If you experience pain or discomfort, over-the-counter pain relief medications may help. However, consult your doctor before taking any new medications.

5. Avoid Prolonged Sitting: If sitting for long periods exacerbates your symptoms, try to take breaks to stand or walk around. This can help alleviate pressure on the surgical site.

6. Mindfulness and Relaxation Techniques: Stress and anxiety can exacerbate discomfort. Techniques such as deep breathing, meditation, or gentle yoga may help you manage discomfort and improve your overall well-being.

In summary, while some sensitivity and discomfort after anal fissure surgery can be normal, persistent or worsening symptoms should be evaluated by a healthcare professional. Open communication with your doctor about your concerns is essential for your recovery. They can provide you with the best guidance tailored to your specific situation and help you navigate any challenges you may be facing post-surgery.

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